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Hospital employee opinion trends indicate that employees are discontented. Yet, there are approaches leaders can take to reverse negative trends and rebuild trust.

Among the top challenges facing health care organizations today are shortages of talent, cost controls and the transition to value-based health care.1 Each directly impacts employees and can make or break a staff’s work experience — both local conditions and the functioning of the larger organization — and ultimately a hospital system’s success. Among the threats to the quality of the employee experience are staff shortages, deficits in manager effectiveness, lack of support for performance improvement and technology limitations.2

Hospitals face a daunting set of decisions when apportioning limited resources to so many people issues. For example, they may need to choose between greater investments in onboarding versus more manager training. In spite of these hurdles, getting the employee experience right can have substantial payoffs. More positive hospital employee experiences have been linked with greater patient satisfaction, better quality of care results, enhanced safety and even lower medical malpractice claim rates.3

How well are hospitals delivering the necessary employee experience? To get to that answer requires a database of employee survey responses over multiple years from hospitals across the U.S. Willis Towers Watson maintains a database of employee opinions. This database includes responses from, on an annual basis over the last six years, 24 organizations, including multi-hospital systems and standalone medical centers, totaling 1.75 million employee survey records from 2012-2017.

Employee opinion experience and trends

Trends specific to this time period paint a grim picture for hospital management. Opinions among employees (tracked as the percentage of respondents who report a favorable opinion in reaction to survey questions) have become less favorable in many areas, with six predominant themes:

Staffing and flexibility

Flexible work arrangements

Performance support

Access to training

Ability to impact results

Voice and respect

Bottom-up feedback opportunity

Respect and fairness from managers

Goal clarity

Understanding organizational objectives

Manager communication of work goals

Communication

Company performance versus goals

Understanding business challenges

Overall engagement

Pride and accomplishment at work

Enabled effort

Freedom from obstacles

Figure 1. Hospital work trends depressing employee sentiment

Trends across these themes suggest an underlying sequence of events that likely unfolded over time to depress employee sentiment. Beginning with shifts from 2012 to 2013, the first cracks appear in basic support, including access to training, understanding work goals and flexible work arrangements, as detailed in Figure 1. Not surprisingly, perceived obstacles at work also began a steep decline.

Figure 2. Communication with employees is a second distress signal

Declining support signals the first potential disconnects between an employer and employee. Delivery of these basics helps to ensure operational efficiencies from well-directed efforts focused on the precise goals of patient care and quality outcomes. It’s not surprising that the next crack was leadership’s communication channels for employee input and messaging. Beginning in 2014 and continuing over much of the study period, declines are evident in manager communication of goals, information on company performance against objectives and upward employee feedback opportunity (Figure 2).

Figure 3. The decline in the employee connection to work

These trends point to both a bottom-up decline in perceived local support combined with a top-down break in two-way communication. A decline in employee engagement trends then begins to appear. Measures of engagement that are tracked include emotional attachments such as pride in the organization, enablement at work through freedom from performance obstacles, and energy generated from accomplishment and social support. As detailed in Figure 3, employees in 2014 began to report less pride and less accomplishment at work. In addition, staff members show declining favorability in related areas such as the intention to stay with their employer and the ability to impact patient experience. Declining engagement is thus beginning to manifest itself in increased retention risk and less clear alignment between work and core organizational objectives.

Figure 4. Decline in engagement after a communication breakdown

With local support eroding, growing disconnects with top leadership and declining engagement, the last relational bonds with the employer begin to fray. From 2015 through 2017, declines in development opportunity, understanding business challenges, believing information from leadership, and perceived respect and fairness were registered, as detailed in Figure 4. Consequently, personal futures and career securities are impacted, eroding a sense of fair play and trust in an organization’s communication. Staff then pulls back on exerting extra effort on the job.

Employee engagement drivers

These are common trends experienced across time, so it’s not surprising that these same aspects of employee opinion are also driving hospital workers’ employee engagement. Specifically, hospital employees across the period report higher engagement to the extent they:

Have greater goal clarity

Enjoy more effective communication with leaders

Report better training to upskill their contributions

Work in adequately staffed departments with more flexibility in work arrangements

Feel more respected, involved and empowered at work

More of our respondents say that there isn’t sufficient staff in their units to work effectively. Specifically, from 2015 through 2017, 25% of employees said staffing was inadequate, up from 20% in 2012, according to respondents. Interestingly, these shifts stem from fewer respondents expressing uncertainty on this question, suggesting concerns about lack of staffing are becoming more evident to hospital employees over time.

How leaders can reverse negative trends

If hospital employees are increasingly discontented, how can we reverse these negative trends? The answer might originate in local work environments, as suggested by several improving trends that are present in the data, despite the areas of decline just reviewed. Specifically, across the study period, employees report more receptivity from local managers to ideas and suggestions. In addition, opinions trend more favorably for survey questions related to staff working together as a team, and working effectively across teams, a key challenge in complex care delivery in hospitals. These improving trends suggest that even as support erodes, disconnects with leadership deepen, and engagement levels feel the strain, it remains imperative to pull together for the patient. Hence, there is a willingness to solicit and execute new ideas and work collectively. These are enduring strengths of the industry’s employee experience.

Line managers are part of the ultimate solution as they influence issues that drive the declining trends, including work flexibility, goal clarity, removing obstacles to job execution, and ensuring top leadership messaging is understood and applied locally. Even so, these findings underscore the need for direct involvement from senior leadership. Investments directed to training and programs to support work-life balance efforts are clear priorities. In addition, less costly efforts to improve communication are essential. Effective messaging must focus on clarifying organizational performance and articulating both near-term goals and long-term future objectives. Concentrated efforts to enhance communication would start to rebuild trust with employees who are increasingly in the dark about their organization’s health and their personal career prospects. With time, leaders at all levels can rebuild the trust that ultimately supports greater employee engagement and the performance lift possible from delivering the optimal employee experience.